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r*j0r9T;-K9P.,N9 <br />LM <br />owner name) on behalf of <br />(company, if applicable) acknowledge that I/we <br />am/are the rightful owner of the property located at <br />SH 123 (see attached exhibit) <br />I hereby authorize Hernan Jaramillo, P. E. <br />Bain Medina Bain, Inc. <br />Annexation <br />(address). <br />(agent name) on behalf of <br />_(agent company) to file this application for <br />(application type), and, if necessary, to work with <br />the Responsible Official / Department on my behalf throughout the process. <br />Signature of Owner: Date: <br />Printed Name, Title: <br />Signature of Agent: <br />L - <br />Printed Name, Title: Hernan J&4millo, P.E. I President <br />Date: V lz9�-e 'gs�Ln' <br />Planning & Development Services - 630 East Hopkins - San Marcos, Texas 75666 - 512-393-8230 <br />